Treatment of Corneal Neovascularization Before Deep Anterior Lamellar Keratoplasty

Purpose: Corneal neovascularization (CNV) can cause intraoperative concerns with deep anterior lamellar keratoplasty (DALK) given the inherent interface. We reviewed the effectiveness of CNV treatments before DALK in minimizing intraoperative and postoperative complications. Methods: A retrospective chart review was conducted on all eyes that 1) underwent DALK and 2) had significant CNV on exam before DALK. Eyes were divided into 2 groups: those that received CNV treatment before DALK (argon laser with subconjunctival bevacizumab/dexamethasone [ABD] and/or mitomycin intravascular chemoembolization [MICE]) and those that did not. Outcome measures included intraoperative complications, postoperative CNV recurrence, and keratoplasty rejection/failure. Results: This analysis included 16 eyes from 16 patients. Ten eyes had prior CNV treatment, whereas 6 did not. The CNV treatment group had no bleeding-related intraoperative complications and no interface blood occurred. The intraoperative bleeding grade was significantly less in the CNV treatment group ( P = 0.024). In the 8 eyes where a big bubble (BB) was attempted (n = 6 ABD only, n = 2 MICE), there was difficulty obtaining a BB in 17% (1 of 6) that underwent ABD only, and 100% (2 of 2) that underwent MICE. Postoperatively, 4 CNV treatment eyes had CNV recurrence; in 3 of these patients, no large caliber vessels recurred. Two patients required additional ABD after DALK to treat the recurrent CNV. Conclusions: Treatments for CNV before DALK were effective in minimizing intraoperative bleeding and recurrence of large caliber vessels. However, recurrence of CNV after DALK is possible and may necessitate ongoing treatment.